Monday, March 14, 2011

Which transition and continuity measures improve post discharge outcomes?

According to this study in the Journal of Hospital Medicine:

After adjusting for important covariates and other continuity scores, increased preadmission physician continuity was independently associated with a decreased risk of urgent readmission (adjusted hazard ratio 0.94 [95% CI, 0.91-0.98] for each absolute increase in continuity of 0.1). Other continuity measures—including hospital physician continuity—were not associated with either outcome.
After discharge from the hospital, increased continuity with physicians who routinely treated the patient prior to the admission was significantly and independently associated with a decreased risk of urgent readmission. These data suggest that continuity with the hospital physician after discharge did not independently influence the risk of patient death or urgent readmission.

The results of this study support the guideline recommendation that the ED physician contact the patient's PCP if admission to a hospitalist is being considered. These results do not support the increasingly popular practice of hospitalists seeing patients in an ambulatory setting for one or two visits post discharge.

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